ah.thefinaldiagnosis-第8部分

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he　brain　into　it。
　Watching　McNeil；　his　hands　steady　and　petent；　Seddons　found　himself　wondering　again　what　went　on　in　the　pathology　resident's　mind。　He　had　known　McNeil　for　two　years；　first　as　a　fellow　resident；　though　senior　to　himself　in　the　hospital's　pyramid　system；　and　then　more　closely　during　his　own　few　months　in　Pathology。　Pathology　had　interested　Seddons；　he　was　glad；　though；　it　was　not　his　own　chosen　specialty。　He　had　never　had　second　thoughts　about　his　personal　choice　of　surgery　and　would　be　glad　when　he　went　back　to　it　in　a　few　weeks'　time。　In　contrast　to　this　domain　of　the　dead　the　operating　room　was　a　territory　of　the　living。　It　was　pulsing　and　alive；　there　was　a　poetry　of　motion；　a　sense　of　achievement　he　knew　he　could　never　find　here。　Each　to　his　own；　he　thought；　and　pathology　for　the　pathologists。
　There　was　something　else　about　pathology。　You　could　lose　your　sense　of　reality；　your　awareness　that　medicine　was　of　and　for　human　beings。　This　brain　now　。　。　。　Seddons　found　himself　acutely　aware　that　just　a　few　hours　ago　it　was　the　thinking　center　of　a　man。　It　had　been　coordinator　of　the　senses…touch；　smell；　sight；　taste。　It　had　held　thoughts；　known　love；　fear；　triumph。　Yesterday；　possibly　even　today；　it　could　have　told　the　eyes　to　cry；　the　mouth　to　drool。　He　had　noticed　the　dead　man　was　listed　as　a　civil　engineer。　This；　then；　was　a　brain　that　had　used　mathematics；　understood　stresses；　devised　construction　methods；　perhaps　had　built　houses；　a　highway；　a　water　works；　a　cathedral…legacies　from　this　brain　for　other　humans　to　live　with　and　use。　But　what　was　the　brain　now？…just　a　mass　of　tissue；　beginning　to　be　pickled　and　destined　only　to　be　sliced；　examined；　then　incinerated。
　Seddons　did　not　believe　in　God　and　he　found　it　hard　to　understand　how　educated　people　could。　Knowledge；　science；　thought…the　more　these　advanced；　the　more　improbable　all　religions　became。　But　he　did　believe　in　what；　for　lack　of　better　phrases；　he　thought　of　as　〃the　spark　of　humanity；　the　credo　of　the　individual。〃　As　a　surgeon；　of　course；　he　would　not　always　deal　with　individuals；　nor　would　he　always　know　his　patients；　and　even　when　he　did　he　would　lose　awareness　of　them　in　concentrating　on　problems　of　technique。　But　long　ago　he　had　resolved　never　to　forget　that　beneath　everything　was　a　patient…an　individual。　In　his　own　training　Seddons　had　seen　the　cocoon　of　personal　isolation…a　safeguard　against　close　contact　with　individual　patients…grow　around　others。　Sometimes　it　was　a　defensive　measure；　a　deliberate　insulation　of　personal　emotions　and　personal　involvement。　He　felt　strong　enough　himself；　though；　to　get　along　without　the　insulation。　Moreover；　to　make　sure　it　did　not　grow；　he　forced　himself　sometimes　to　think　and　soliloquize　as　he　was　doing　now。　Perhaps　it　would　surprise　some　of　his　friends　who　thought　of　Mike　Seddons　only　as　a　buoyant　extrovert　to　know　some　of　the　thoughts　that　went　on　inside　him。　Perhaps　it　wouldn't；　though；　the　mind；　brain…or　whatever　you　called　it…was　an　unpredictable　machine。
　What　of　McNeil？　Did　he　feel　anything；　or　was　there　a　shell　around　the　pathology　resident　too？　Seddons　did　not　know；　but　he　suspected　there　was。　And　Pearson？　He　had　no　doubts　there。　Joe　Pearson　was　cold　and　clinical　all　the　way　through。　Despite　his　showmanship　the　years　of　pathology　had　chilled　him。　Seddons　looked　at　the　old　man。　He　had　removed　the　heart　from　the　body　and　was　scrutinizing　it　carefully。　Now　he　turned　to　the　student　nurses。
　〃The　medical　history　of　this　man　shows　that　three　years　ago　he　suffered　a　first　coronary　attack　and　then　a　second　attack　earlier　this　week。　So　first　we'll　examine　the　coronary　arteries。〃　As　the　nurses　watched　intently　Pearson　delicately　opened　the　heart…muscle　arteries。
　〃Somewhere　here　we　should　discover　the　area　of　thrombosis　。　。　。　yes；　there　it　is。〃　He　pointed　with　the　tip　of　a　metal　probe。　In　the　main　branch　of　the　left　coronary　artery；　an　inch　beyond　its　origin；　he　had　exposed　a　pale；　half…inch　clot。　He　held　it　out　for　the　girls　to　see。
　〃Now　we'll　examine　the　heart　itself。〃　Pearson　laid　the　organ　on　a　dissecting　board　and　sliced　down　the　center　with　a　knife。　He　turned　the　two　sections　side　by　side；　peered　at　them；　then　beckoned　the　nurses　closer。　Hesitantly　they　moved　in。
　〃Do　you　notice　this　area　of　scarring　in　the　muscle？〃　Pearson　indicated　some　streaks　of　white　fibrous　tissue　in　the　heart；　and　the　nurses　craned　over　the　gaping　red　body　cavity　to　see　more　closely。　〃There's　the　evidence　of　the　coronary　attack　three　years　ago…an　old　infarct　which　has　healed。〃
　Pearson　paused；　then　went　on。　〃We　have　the　signs　of　the　latest　attack　here　in　the　left　ventricle。　Notice　the　central　area　of　pallor　surrounded　by　a　zone　of　hemorrhage。〃　He　pointed　to　a　small　dark…red　stain　with　a　light　center；　contrasting　with　the　red…brown　texture　of　the　rest　of　the　heart　muscle。
　Pearson　turned　to　the　surgical　resident。　〃Would　you　agree　with　me；　Dr。　Seddons；　that　the　diagnosis　of　death　by　coronary　thrombosis　seems　fairly　well　established？〃
　〃Yes；　I　would；〃　Seddons　answered　politely。　No　doubt　about　it；　he　thought。　A　tiny　blood　clot；　not　much　thicker　than　a　piece　of　spaghetti；　that　was　all　it　took　to　cut　you　off　for　good。　He　watched　the　older　pathologist　put　the　heart　aside。
　Vivian　was　steadier　now。　She　believed　she　had　herself　in　hand。　Near　the　beginning；　and　when　the　saw　had　cut　into　the　dead　man's　skull；　she　had　felt　the　blood　drain　from　her　head；　her　senses　swim。　She　knew　then　she　had　been　close　to　fainting　and　had　determined　not　to。　For　no　reason　she　had　suddenly　remembered　an　incident　in　her　childhood。　On　a　holiday；　deep　in　the　Oregon　forest；　her　father　had　fallen　on　an　open　hunting　knife　and　cut　his　leg　badly。　Surprisingly　in　so　strong　a　man；　he　had　quailed　at　the　sight　of　so　much　of　his　own　blood；　and　her　mother；　usually　more　at　home　in　the　drawing　room　than　the　woods；　had　bee　suddenly　strong。　She　had　fashioned　a　tourniquet；　stemmed　the　blood；　and　sent　Vivian　running　for　help。　Then；　with　Vivian's　father　being　carried　through　the　woods　on　an　improvised　litter　of　branches；　every　half…hour　she　had　released　the　tourniquet　to　keep　circulation　going；　then　tightened　it　to　halt　the　bleeding　again。　Afterward　the　doctors　had　said　she　had　saved　the　leg　from　amputation。　Vivian　had　long　since　forgotten　the　incident；　but　remembering　it　now　had　given　her　strength。　After　that　she　knew　there　would　not　be　any　problem　about　watching　an　autopsy　again。
　〃Any　questions？〃　It　was　Dr。　Pearson　asking。
　Vivian　had　one。　〃The　organs…those　that　you　take　out　of　the　body。　What　happens　to　them；　please？〃
　〃We　shall　keep　them；　probably　for　a　week。　That　is…the　heart；　lungs；　stomach；　kidneys；　liver；　pancreas；　spleen；　and　brain。　Then　we　shall　make　a　gross　examination　which　will　be　recorded　in　detail。　At　that　time　also　we'll　be　studying　organs　removed　at　other　autopsies…probably　six　to　a　dozen　cases　all　together。〃
　It　sounded　so　cold　and　impersonal；　Vivian　thought。　But　maybe　you　had　to　get　that　way　if　you　did　this　all　the　time。　Involuntarily　she　shuddered。　Mike　Seddons　caught　her　eye　and　smiled　slightly。　She　wondered　if　he　was　amused　or　being　sympathetic。　She　could　not　be　sure。　Now　one　of　the　other　girls；　was　putting　a　question。　She　sounded　uneasy；　almost　afraid　to　ask。　〃The　body…is　it　buried　then　。　。　。　just　by　itself？〃
　This　was　an　old　one。　Pearson　answered　it。　〃It　varies。　Teaching　centers　such　as　this　usually　do　more　study　after　autopsies　than　is　done　in　non…teaching　hospitals。　In　this　hospital　just　the　shell　of　the　body　goes　on　to　the　undertakers。〃　He　added　as　an　afterthought：　〃They　wouldn't　thank　us　for　putting　the　organs　back　anyway。　Just　be　a　nuisance　when　they're　embalming。〃
　That　was　true；　McNeil　reflected。　Maybe　not　the　gentlest　way　of　putting　it；　but　true　all　the　same。　He　had　sometimes　wondered　himself　if　mourners　and　others　who　visited　funeral　parlors　knew　how　little　remained　in　a　body　that　had　been　autopsied。　After　an　autopsy　like　this　one；　and　depending　on　how　busy　a　pathology　department　was；　it　might　be　weeks　before　the　body　organs　were　disposed　of　finally；　and　even　then　small　specimens　from　each　were　kept　stored　indefinitely。
　〃Are　there　never　any　exceptions？〃　The　student　nurse　asking　the　questions　seemed　persistent。　Pearson　did　not　appear　to　object　though。　Maybe　this　is　one　of　his　patient　days；　McNeil　thought。　The　old　man　had　them　occasionally。
　〃Yes；　there　are；〃　he　was　saying。　〃Before　we　can　do　any　autopsy　we　must　have　permission　from　the　family　of　the　deceased。　Sometimes　that　permission　is　unrestricted；　as　in　this　case；　and　then　we　can　examine　the　entire　head　and　torso。　At　other　times　we　may　get　only　limited　permission。　For　example；　a　family　may　ask　specifically　that　the　cranial　contents　be　undisturbed。　When　that　happens　in　this　hospital　we　respect　those　wishes。〃
　〃Thank　you；　Doctor。〃　Apparently　the　girl　was　satisfied；　whatever　her　reason　had　been　for　asking。
　But　Pearson　had　not　finished。
　〃You　do　run　into　cases　where　for　reasons　of　religious　faith　the　organs　are　required　for　burial　with　the　body。　In　that　case；　of　course；　we　ply　with　the　request。〃
　〃How　about　Catholics？〃　It　was　one　of　the　other　girls　this　time。　〃Do　they　insist　on　that？〃
　〃Most　of　them　don't；　but　there　are　some　Catholic　hospitals　which　do。　That　makes　the　pathologist's　work　difficult。　Usually。〃
　As　he　added　the　last　word　Pearson　glanced　sardonically　at　McNeil。　Both　of　them　knew　what　Pearson　was　thinking…one　of　the　larger　Catholic　hospitals　across　town　had　a　standing　order　that　the　organs　of　all　bodies　autopsied　were　to　be　returned　to　the　body　for　burial。　But　sometimes　a　little　sleight　of　hand　was　practiced。　The　busy　pathology　department　of　the　other　hospital　frequently　kept　a　spare　set　of　organs　on　hand。　Thus；　when　a　new　autopsy　was　done；　the　organs　removed　were　replaced　by　the　spare　ones；　so　that　the　body　could　be　released　and　the　latest　set　of　organs　examined　at　leisure。　These　organs；　in　turn；　were　then　used　for　the　next　body。　Thus　the　pathologists　were；　in　effect；　always　one　ahead　of　the　game。
　McNeil　knew　that　Pearson；　though　not　a　Catholic；　disapproved　of　this。　And　whatever　else　you　might　say　about　the　old　man；　he　always　insisted　on　following　autopsy　permissions　both　to　the　letter　and　the　spirit。　There　was　one　phrase；　sometimes　used　in　plet